title: Patient safety in plastic surgery: identifying areas for quality improvement efforts.
abstract: Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P < 0.01). Patient characteristics associated with a higher risk-adjusted rate per 1000 patients at risk included older age, men, nonwhite, and public payer (P < 0.05). Overall, plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.
authors.affiliation: From the *Department of Surgery, Stanford University School of Medicine; †Center for Health Policy, Stanford University, Stanford; ‡Rehabilitation Research and Development, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto; and §Division of Plastic Surgery, Stanford University, Stanford, CA.
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: McDonald
authors.forename: Kim F
authors.initials: KF
authors.lastname: Rhoads
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Curtin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015187:Lipectomy / Q000592:standards; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D061214:Patient Safety / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000592:standards* / Q000706:statistics & numerical data; D020379:Risk Adjustment; D012307:Risk Factors; D013518:Surgery, Plastic / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult